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Why are the odds of surviving a heart attack better in the NW?

By knkx on Thu, 03/01/2012 - 16:40

Audio:

By Keith Seinfeld

In 1974, CBS’ 60 Minutes declared Seattle was the best place in the world to suffer a heart attack. Nearly forty years later, the reputation persists – and experts are still claiming Seattle is tops in saving victims of cardiac arrest.

The legend started when Morley Safer, of CBS, told his national TV audience:

“There's a pretty good chance that if one of you right this minute had a heart attack you'd be dead pretty quickly. That message may apply to everyone watching this broadcast, except those who happen to live in Seattle. If you live in Seattle, the odds are good you’d live to tell the tale.”

Watch an excerpt

Safer rode around with his 60-Minutes camera crew in a Seattle Fire Department Medic-One unit, marveling at how it was like a small hospital room on wheels. This was a novelty in the early 1970’s. A typical ambulance at that time had low ceilings, and was just big enough to fit a stretcher in back.

This TV broadcast got Seattle’s reputation started. But why here – and why has the reputation lasted until today?

It turns out Seattle was part of a big revolution in medical care that started in the 1950’s and 60’s.

First came the invention of CPR – pumping the chest to save someone’s life (yes, it had to be invented). And around the same time, a new medical gadget emerged, called an electronic defibrillator. You’ve seen it on TV, too – delivering electric shocks to jump-start someone’s heart. Both of these innovations were reviving people inside hospitals whose hearts stopped beating.

“All these things were there. And we took the components and mixed them up and put them in a truck, and sent them on their way,” says Dr. Leonard Cobb, an emeritus cardiologist at the University of Washington and the founder and inventor of Medic One services in Seattle.

‘No legal precendent’

Cobb got the idea from a doctor name Frank Pantridge in Belfast, Northern Ireland, who published an article about how many lives he was saving with his mobile heart unit.

Cobb called up Seattle’s fire chief and they agreed to a partnership, to prove this could work and save lives.

“There was no legal precedent for doing this kind of thing,” having someone besides licensed doctors and nurses delivering medical care, says Cobb. At first, they had a doctor ride-along for every call. Paramedics didn’t really exist yet. Nor did “Emergency Medical Technicians.”

They also needed a new type of vehicle, where you could stand up inside.

Medic One launched in 1970 with a converted mobile-home as the rescue unit. That didn’t work out because it was unstable.

“You could go fast, but you didn’t want to go around the corners very fast,” says Cobb.

TV drama popularized the procedure

Version two was the truck-mounted rescue units you see today.

During the first couple years, they proved firefighters could deliver CPR, and follow a doctor’s instructions over a two-way radio. Similar innovation was happening in a handful of cities, including Los Angeles, where Hollywood producer Jack Webb caught wind.

Soon came a popular TV drama called Emergency! With its regular refrain:

“Rampart -- this is rescue 51.”

Firefighter paramedics were the stars. They showed America a new type of medicine – where you revive people outside the hospital.

Before long, cities around the country were setting up emergency systems. And yet Seattle was managing to save more lives than the others.

Under Dr. Cobb’s leadership, and his colleague Dr. Michael Copass, they created a perfectionist culture.

“There's a system that is always trying to say, ‘How can we do it better?’ We will never accept the status quo,” says Dr. Mickey Eisenberg, medical director of King County Medic One, and author of a textbook on emergency resuscitation. “Every event is studied with the question being, ‘How can we do better next time?’ ”

Like choreography

Every step of the response is scrutinized, from the moment you call 911 until the victim is stabilized in the hospital. Eisenberg says that culture of improvement makes a big difference. It’s led to several seemingly minor differences in King County that add up to more lives saved.

1) Training for paramedics and firefighters in King County goes beyond national standards. When someone calls reporting a sudden heart attack, they want a crew of eight or ten rescuers to show up at your doorstep – and be so well rehearsed, they barely need to speak. It’s like choreography.

Seattle Fire Capt. Jonathan Larsen compares it to a pit-crew at the Indy 500, where everyone knows their job and can do it quickly. They focus their training on a type of heart attack called cardiac arrest. It’s the one emergency where only CPR and electrical shock can save the victim. If you wait until they get to the hospital, they’ll be dead.

2) The 911 dispatchers coach people over the phone on how to give CPR. (Below is a 30-second excerpt from a real call giving "dispatch-assisted CPR")

If you wait five minutes for the fire truck to arrive, the victim may not survive. Even if they live, starting CPR sooner makes an enormous difference in whether they fully recover.

3) Defibrillators in public are the latest improvement. An AED is an automatic defibrillator, and the technology has improved dramatically over the years – thanks in part to a local company, Physio-Control, based in Redmond, Wash.

Physio developed the first portable defibrillators back in the 1960’s. Back then, there was concern that only a trained doctor could operate the device, because if you shock the wrong person, or at the wrong time, it could be fatal.

Friends used it to save a life

The newest models are so easy, anyone can use them – which is why there’s a big push to get AED’s in public spaces.

Last fall, Seattle Public Schools, working with the local Nick of Time Foundation, put LifePak AED’s in every school building.

It was truly just in time for Jamie Alls, 45, of Seattle. He was playing basketball with friends last November in a school gym, in the evening.

“Jamie felt some pain, and he asked, Hey, can one of you guys come in for me?” says John Santos, a friend who works at the school. A few minutes later, Jamie asked someone to call 911, because his chest was hurting. Then he collapsed.

“He’s stretched out on the floor and there's no response. He’s like a bluish gray. And we just said to ourselves, ‘How are we going to help him?’ ” says Santos. One friend started CPR, pumping on Alls’ chest.

“I remembered that an AED unit was just brought into the building ten days before, and I ran and got it.”

It looks like a black lunchbox, kept in a case on the wall. When Santos opened it up, an automated voice started barking instructions:

“Remove all clothing from the patient’s chest …” and “apply pad to bare skin exactly as shown in the picture …”

“It zaps him,” says Santos, “His eyes open up, and after that the bluish gray color was gone, immediately. And he’s opening his eyes and you can tell he’s not 100 percent here yet. But you can tell he’s now alive.”

A few minutes later, Medic One arrived. Alls’ heart needed seven more agonizing electric shocks to keep him alive, before he headed into surgery. But he made it, and just three months later, he’s fully recovered.

He’s yet another one of King County’s good statistics – double the national rate of the cardiac arrest victims saved – thanks to America’s best-trained medics and best-trained public.